tag:blogger.com,1999:blog-33485645123985700822024-03-12T16:03:13.175-06:00Oncology Professional Rebels Network"Be the change that you wish to see in the [oncology and palliative] world." -- Mahatma Gandhi [adapted]cralphhttp://www.blogger.com/profile/17716398305539789239noreply@blogger.comBlogger184125tag:blogger.com,1999:blog-3348564512398570082.post-79317577570940150362017-02-24T10:16:00.000-07:002017-02-27T14:37:58.316-07:00Prescription Opioids Available in Canada <span style="background-color: white; font-family: "georgia" , "times" , serif; font-size: 13.12px; line-height: 20.992px; text-align: justify;">The following table highlights currently available prescription opioids in Canada, including formulations and strengths. Any of the coverage notes are specific to the province of Alberta.</span><br />
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<b>Credit:</b> Table composed by Kevin Thai and Humirah Sultanicralphhttp://www.blogger.com/profile/17716398305539789239noreply@blogger.com0tag:blogger.com,1999:blog-3348564512398570082.post-70127603606205930762016-09-20T10:13:00.000-06:002016-09-20T10:13:11.389-06:00Virtual Conference: CAPhO's Oncology Fundamentals Day October 1, 2016What a brilliant initiative from CAPhO's (Canadian Association of Pharmacy in Oncology) Education Committee! A virtual conference on oncology pharmacy fundamentals - fully accredited.<br />
<br />
Are you new to oncology or a general pharmacy practitioner with cancer patients in your practice?<br />
Are you looking for core education on common oncology diseases and cancer treatment toxicities?<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmP7idtRFWrExUgYtm01cEef3D2UJs6QRYpLGFqwTWk_rK0-7yhwbL1K-RcjQ1Ny1PuyzZkfXhfceh-0hUJDgpOPAPZzWYhHPg4hIf_WVGmo-pQqeSFhnFImcnrX86-x72v1tJt6UpgK-Y/s1600/OFD+Logo+%25401.25x.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmP7idtRFWrExUgYtm01cEef3D2UJs6QRYpLGFqwTWk_rK0-7yhwbL1K-RcjQ1Ny1PuyzZkfXhfceh-0hUJDgpOPAPZzWYhHPg4hIf_WVGmo-pQqeSFhnFImcnrX86-x72v1tJt6UpgK-Y/s320/OFD+Logo+%25401.25x.png" width="309" /></a></div>
<br />
Attend the Canadian Association of Pharmacy in Oncology (CAPhO) Oncology Fundamentals Day (<a href="https://twitter.com/search?q=%23OFD16&src=typd" target="_blank">#OFD16</a>), taking place on Saturday, October 1, 2016. Join us for a full day CCCEP accredited online professional development opportunity from wherever you are. The program information is found at the<a href="http://www.capho.org/oncology-fundamentals-day-program" target="_blank"> link </a>below:<br />
<a href="http://www.capho.org/oncology-fundamentals-day-program">http://www.capho.org/oncology-fundamentals-day-program</a><br />
<br />cralphhttp://www.blogger.com/profile/17716398305539789239noreply@blogger.com0tag:blogger.com,1999:blog-3348564512398570082.post-27718166539084729842015-07-21T14:05:00.001-06:002015-07-22T09:32:41.549-06:00Losing That Restless Feeling: Drug-Induced Akathisia Treatment Options<h3>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtawaN5L_SeSK76I4caW-Pqb_J40TTQPGHIXPJLPnSfvW6pEcD3XN4wqRglf0AmQm3QkXPca9YtjdBxm9vkvpqjRNee-vYqAYSeq8SJtH2X3sdVmPOV1BFfNaC1MTOawqFq_IqjJ6raqwd/s1600/waterfall-828948_640.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtawaN5L_SeSK76I4caW-Pqb_J40TTQPGHIXPJLPnSfvW6pEcD3XN4wqRglf0AmQm3QkXPca9YtjdBxm9vkvpqjRNee-vYqAYSeq8SJtH2X3sdVmPOV1BFfNaC1MTOawqFq_IqjJ6raqwd/s320/waterfall-828948_640.jpg" width="320" /></a></div>
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<span style="color: blue; font-family: inherit; font-size: 16px;">Akathisia</span></h3>
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<span style="font-family: inherit; font-size: 16px; font-weight: normal;">Akathisia (from the Greek καθίζειν: inability to sit) is one of the most prevalent and distressful psychotropic-induced extrapyrimidal adverse effects. It is a neuropsychiatric syndrome characterized by both subjective (inner feeling) and objective (physical symptoms) restlessness.</span></div>
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<span style="font-family: inherit; font-size: 16px; font-weight: normal;">Due to this inner restlessness, patients may experience fidgeting, pacing, rocking while standing or sitting, crossing and uncrossing legs while sitting, and constant movement of the feet. Patients have also described these feelings as “wanting to jump out of my skin”and as a “crawling skin sensation.” (4)</span></div>
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<span style="font-size: 16px; font-weight: normal;">Among the drugs used to treat delirium, haloperidol, might be the antipsychotic with the highest risk for development of akathisia. (5) </span><span style="font-family: inherit; font-size: 16px; font-weight: normal;">The risk for akathisia in patients with delirium taking antipsychotics appears to be a dose-related phenomenon. </span><span style="font-family: inherit; font-size: 16px; font-weight: normal;">Effective and well tolerated treatment is a major unmet need in akathisia that merits a search for new remedies.</span></div>
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<span style="color: blue; font-family: inherit; font-size: 16px;">Assessment Scales</span></h3>
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<span style="font-family: inherit; font-size: 16px; font-weight: normal;">"Studies using specific scales for evaluation of akathisia in delirium are lacking. Some populations, such as patients with cancer or terminally ill patients in palliative care settings taking antipsychotics for the treatment of delirium, could be at higher risk for development of akathisia as a side effect." (5)</span></div>
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<span style="font-family: inherit; font-size: 16px;"><span style="font-weight: normal;">The <a href="http://simpleandpractical.com/barnes-akathisia-rating-scale/" target="_blank">Barnes Akathisia Rating Scale</a> (BARS) is one such scale</span>.</span></div>
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<span style="color: blue; font-family: inherit; font-size: 16px;">Treatment </span><br />
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<span style="font-family: inherit;"><span style="font-size: 16px; font-weight: normal;">Early management of akathisia is important because it may be associated with poor treatment respo</span><span style="font-size: 16px; font-weight: normal;">nse and medication noncompliance, and most importantly is distressing to the patient and caregivers. Unfortunately many patients fail to respond to standard management of akathisia (typically benzodiazepines, beta blockers, anticholinergic agents). As medications used to alleviate akathisia symptoms such as anticholinergics and benzodiazepines could potentially worsen delirium, management of akathisia among delirious patients on antipsychotics should be further studied to explore the efficacy of other agents.</span></span></div>
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<span style="font-family: inherit; font-size: 16px; font-weight: normal;">In addition to dopaminergic mechanisms, it has been hypothesized that serotonin may play a prominent role in the pathophysiology of akathisia. </span></div>
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<span style="font-family: inherit;"><span style="font-size: 16px;"><i>Trazodone</i></span><span style="font-size: 16px; font-weight: normal;"> is an antidepressant agent demonstrating prominent serotonergic antagonistic properties. An</span><span style="font-size: 16px; font-weight: normal;"> open-label pilot study investigated the efficacy of trazodone in the management of akathisia. Nine female patients with a score of at least “mild akathisia” on the Barnes Akathisia Scale, and receiving a stable dose of antipsychotic medication, were administered trazodone, titrated up to a dosage of 100 mg/day over a period of 5 days. The patients demonstrated marked improvement in symptoms of akathisia. In addition, some </span></span><span style="font-family: inherit; font-size: 16px; font-weight: normal;">improvement was noted in symptomatology of anxiety, depression, and psychosis. (3)</span></div>
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<span style="font-family: inherit;"><i><br /></i></span></div>
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<span style="font-family: inherit; font-size: 16px;"><i>Low-dose mirtazapine</i></span><span style="font-family: inherit; font-size: 16px; font-weight: normal;"> was found to be efficacious for neuroleptic-induced akathisia. (2) "</span><span style="font-size: 12pt; font-weight: normal; line-height: 115%;"><span style="font-family: inherit;">The
most compelling evidence indicating that 5-HT2A antagonists may represent a new
class of effective anti-akathisia agent comes from the largest-to-date
randomised controlled trial comparing low-dose mirtazapine with propranolol in
90 patients with FGA-induced (first-generation antipsychotics) acute akathisia. Mirtazapine is characterised by
potent presynaptic alpha-2 adrenergic antagonism, which accounts for its
antidepressant activity, and marked 5-HT2A blockade that seems to preponderate
in a low dose and contribute to its anti-akathisia properties. <i>Mirtazapine,
given once daily (15 mg) was as effective as propranolol (80 mg twice daily) in
producing a greater improvement in akathisia compared with placebo</i> (reduction
in BARS global scale: 1.10 (s.d. = 1.37) points (34%) and 0.80 (s.d. = 1.11)
points (29%) v. 0.37 (s.d. = 0.72) points (11%) respectively; P = 0.036).
Responder analysis (BARS global scale reduction 52) yielded a similar robust
anti-akathisia effect in mirtazapine and propranolol v. placebo (43.3% and 30%
v. 6.7% respectively; P = 0.005). <i>Low numbers needed to treat (3</i> and 4
respectively) support high clinical efficacy of both compounds. Importantly,
mirtazapine achieved an anti-akathisia effect with more convenient dosing than
propranolol and better tolerability, with mild transient sedation as the only
observed side-effect. The favourable mirtazapine safety profile was also
supported by the absence of significant changes in vital signs." (1)</span></span><br />
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<span style="color: blue; font-family: inherit; font-size: 16px;">Suggested Approach</span></h3>
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<span style="font-family: inherit; font-size: 16px; font-weight: normal;">Discontinue [alternatively, dose decrease] the offending agent. If this is not possible or ease of symptoms is required, w</span><span style="font-family: inherit; font-size: 16px; font-weight: normal;">hen the decision is to add an anti-akathisia agent</span><br />
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<ul>
<li><span style="font-family: inherit; font-size: 16px; font-weight: normal;">propranolol (40–80 mg/day twice daily) or </span></li>
<li><span style="font-family: inherit; font-size: 16px;">low-dose mirtazapine (15 mg once daily)</span><span style="font-family: inherit; font-size: 16px; font-weight: normal;"> as first-line treatment have the most supportive evidence.</span></li>
<li><span style="font-family: inherit; font-size: 16px; font-weight: normal;">Mianserin (15 mg once daily) and cyproheptadine (8–16 mg/ day) are alternative options</span></li>
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<li><span style="font-family: inherit; font-size: 16px; font-weight: normal;">however, large-scale trials are not yet available. (1)</span></li>
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<span style="color: blue; font-family: inherit; font-size: 16px;">References</span><br />
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<span style="font-family: inherit; font-size: 16px; font-weight: normal;">1.<span class="Apple-tab-span" style="white-space: pre;"> </span><a href="http://bjp.rcpsych.org/content/bjprcpsych/196/2/89.full.pdf" target="_blank">http://bjp.rcpsych.org/content/bjprcpsych/196/2/89.full.pdf </a> </span></div>
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<span style="font-family: inherit; font-size: 16px; font-weight: normal;">2.<span style="white-space: pre;"> </span><a href="http://journals.lww.com/intclinpsychopharm/Abstract/2014/09000/Beneficial_effect_of_low_dose_mirtazapine_in_acute.8.aspx" target="_blank">http://journals.lww.com/intclinpsychopharm/Abstract/2014/09000/Beneficial_effect_of_low_dose_mirtazapine_in_acute.8.aspx </a></span></div>
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<span style="font-family: inherit; font-size: 16px; font-weight: normal;">3.<span class="Apple-tab-span" style="white-space: pre;"> </span><a href="http://www.researchgate.net/publication/10728695_Treatment_of_neuroleptic-induced_akathisia_with_the_5-HT2A_antagonist_trazodone" target="_blank">http://www.researchgate.net/publication/10728695_Treatment_of_neuroleptic-induced_akathisia_with_the_5-HT2A_antagonist_trazodone </a></span></div>
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<span style="font-family: inherit; font-size: 16px; font-weight: normal;">4.<span class="Apple-tab-span" style="white-space: pre;"> </span><a href="http://www2.nami.org/Template.cfm?Section=ask_the_pharmacist&template=/ContentManagement/ContentDisplay.cfm&ContentID=128836">http://www2.nami.org/Template.cfm?Section=ask_the_pharmacist&template=/ContentManagement/ContentDisplay.cfm&ContentID=128836</a> </span></div>
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<span style="font-family: inherit; font-size: 16px;"><span style="font-weight: normal;">5.<span class="Apple-tab-span" style="white-space: pre;"> </span><a href="http://www-ncbi-nlm-nih-gov.login.ezproxy.library.ualberta.ca/pubmed/260878"><span id="goog_1151467131"></span>http://www-ncbi-nlm-nih-gov.login.ezproxy.library.ualberta.ca/pubmed/260878</a></span><a href="https://www.blogger.com/">17 <span id="goog_1151467132"></span></a></span></div>
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</h3>
cralphhttp://www.blogger.com/profile/17716398305539789239noreply@blogger.com0tag:blogger.com,1999:blog-3348564512398570082.post-6661697341470197922015-07-10T14:34:00.000-06:002015-07-20T09:51:57.091-06:00Opioids Available in CanadaThe following table highlights currently available prescription opioids in Canada, including formulations and strengths. Any of the coverage notes are specific to the province of Alberta.<br />
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<i>Click on the download icon (upper right hand corner) or the title below to view table in full screen mode.</i><br />
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<b>Opioids Available in Canada:</b><br />
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<iframe allowfullscreen="" frameborder="0" height="400" msallowfullscreen="" src="https://app.box.com/embed/preview/kdgga3f5hhenw89p86j652is7n0wqvjk?view=&sort=&direction=ASC&theme=light" webkitallowfullscreen="" width="500"></iframe>cralphhttp://www.blogger.com/profile/17716398305539789239noreply@blogger.com0tag:blogger.com,1999:blog-3348564512398570082.post-48983602201476731702015-06-11T15:21:00.003-06:002015-06-12T09:00:31.939-06:00Medical Marijauna: All Formulations Now Legal; Cannabis Harms Brain, Fails in Cancer Pain Study<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhH92Fbq-IMNRW-dxKffS-v_00CjbKHpKPJgj3QDVDL8RN5kfF5VSqYCNpORVcb2tlv2eOnqbkmwZ53V1pyAIwyBGWSR8k5Z60jMOM9gpTKEvIekp9HUx5cd6vcRLPr7gL9GzvUcH4rgNkv/s1600/Medical-Cannabis1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="212" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhH92Fbq-IMNRW-dxKffS-v_00CjbKHpKPJgj3QDVDL8RN5kfF5VSqYCNpORVcb2tlv2eOnqbkmwZ53V1pyAIwyBGWSR8k5Z60jMOM9gpTKEvIekp9HUx5cd6vcRLPr7gL9GzvUcH4rgNkv/s320/Medical-Cannabis1.jpg" width="320" /></a></div>
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<br /></div>
<div dir="ltr">
<span style="font-family: inherit;">1. You might have heard the news by
now:</span></div>
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<span style="font-family: inherit;">- Ruling in Canada this AM:</span></div>
<div dir="ltr">
<strong><span style="font-family: inherit;"><br /></span></strong></div>
<div dir="ltr">
<strong><span style="font-family: inherit;">Medical marijuana legal in all forms, Supreme Court
rules (via </span></strong><b style="font-family: inherit;"><a href="http://www.cbc.ca/news/politics/medical-marijuana-legal-in-all-forms-supreme-court-rules-1.3109148" target="_blank">CBC</a>)</b></div>
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<span style="font-family: inherit;"><br /></span></div>
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<span style="font-family: inherit;">Excerpt:</span></div>
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<span style="font-family: inherit;">"Medical marijuana patients will now be
able to consume marijuana — and not just smoke it — as well as use other
extracts and derivatives, the Supreme Court of Canada ruled
today."</span></div>
<div dir="ltr">
<br /></div>
<div dir="ltr">
This is an important ruling for patients as we see more and more form - for instance, with cannabis oil being all the buzz these days.</div>
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</div>
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<span style="font-family: inherit;">2. That's the "good" news for patients; now for some sobering updates:</span></div>
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<span style="font-family: inherit;"><br /></span></div>
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<strong><span style="font-family: inherit;">Cannabis Harms Brain, Imaging Shows (via <a href="http://www.medscape.com/viewarticle/846094?src=emailthis" target="_blank">Medscape</a>)</span></strong></div>
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<strong><span style="font-family: inherit;"><br /></span></strong></div>
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<span style="font-family: inherit;">Excerpts:</span></div>
<div dir="ltr">
<span style="font-family: inherit;">" The heavy, long-term use of cannabis is associated with negative
changes in parts of the brain not previously implicated, and is linked to
deficits in learning and memory, new research suggests."</span></div>
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</div>
<div dir="ltr">
<span style="font-family: inherit;">"Cannabis shares a negative impact on dopaminergic transmission
with other drugs, only with a different regional profile," explained Dr
Abi-Dargham. </span><span style="font-family: inherit;">An exploratory analysis showed a significant association between
lower dopamine release capacity in the associative striatum and decreased
cognitive measures in probabilistic category learning and working memory tasks,
Dr Weinstein reported.</span></div>
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<span style="font-family: inherit;">In their study, the team compared 11 heavy cannabis users with 12
healthy control subjects, all approximately 28 years of age."</span></div>
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<br /></div>
<span style="font-family: inherit;">"The blunting of dopamine release that they find fits with other studies
showing reduced dopamine synthesis in cannabis users. This could be linked to
the addictive potential of cannabis and other problems, such as lack of
motivation, seen in regular users," Dr Howes told <i>Medscape Medical
News</i>."</span><br />
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</div>
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<span style="font-family: inherit;">3. From January, but relevant when considering prescribing Sativex (which has refractory advanced cancer pain as indication in Canada):</span><br />
<h1 class="article-headline">
<span style="font-family: inherit; font-size: small;">GW Pharma's cannabis
drug [Sativex] fails in cancer pain study, shares
fall (via <a href="http://www.reuters.com/article/2015/01/08/us-gw-pharma-epilepsy-idUSKBN0KH13U20150108" target="_blank">Reuters</a>)</span></h1>
</div>
<div dir="ltr">
<span style="font-family: inherit;">Excerpts:</span></div>
<br />
<div dir="ltr">
<span style="font-family: inherit;">"<span class="focusParagraph">An experimental cannabis drug failed to alleviate pain in cancer
patients as hoped in a clinical study, sending shares in its British maker GW
Pharmaceuticals as much as 21 percent lower on Thursday.</span><span id="midArticle_1"></span>
</span><span style="font-family: inherit;">GW, which is developing the drug <strong>Sativex
</strong>for pain in collaboration with Japan's Otsuka, said the first of three
late stage trials found no statistically significant difference between subjects
using its product and those given a placebo.</span><br />
<span style="font-family: inherit;"><br /></span>
<span style="font-family: inherit;"><span id="midArticle_2"></span>
</span><span style="font-family: inherit;">GW Chief Executive Justin Gover said the findings
were both disappointing and surprising, given encouraging results in earlier
tests, but the company's scientists had not given up hope. </span><span style="font-family: inherit;">Results from two further Phase III trials are due
later this year and, if positive, could still allow the drug to be submitted for
treating pain in patients with advanced cancer, where it is designed to be given
on top of opioids.</span><br />
<span style="font-family: inherit;"><br /></span>
<span style="font-family: inherit;"><span id="midArticle_4"></span><span class="first-article-divide"></span>
</span><span style="font-family: inherit;">"Although we missed the primary endpoint in this
trial, based upon the positive data seen in the Phase II programme, we remain
confident in the ability for Sativex to relieve cancer pain in this patient
population,” Gover said."</span></div>
cralphhttp://www.blogger.com/profile/17716398305539789239noreply@blogger.com0tag:blogger.com,1999:blog-3348564512398570082.post-15094896799288413342015-04-14T10:14:00.001-06:002015-04-14T10:14:09.499-06:00Expired Medications: Drugs past the "best before date" may lose potency, but how soon?<span style="font-family: Verdana, sans-serif;"><a href="http://www.canadianhealthcarenetwork.ca/pharmacists/news/drug-news/medications-past-best-before-date-may-lose-potency-but-how-soon-30927?utm_source=EmailMarketing">Medications past best before date may lose potency, but how soon? | Canadian Healthcare Network - Pharmacists</a>: </span><br /><br />
<span style="font-family: Verdana, sans-serif;"><br /></span><br />
<span style="font-family: Verdana, sans-serif;">Excerpt of key points from the article:</span><br /><br />
<div style="background-color: white; line-height: 16.7999992370605px; margin-bottom: 1.3em; margin-top: 1.3em;"><span style="font-family: Verdana, sans-serif;">"Suggesting it’s better to be safe than sorry, Emberley [<span style="line-height: 16.7999992370605px;">Phil Emberley, director of pharmacy innovation at the Canadian Pharmacists Association] </span><span style="line-height: 16.7999992370605px;">advises consumers to cull any out-of-date drugs from their medicine cabinets and take them to a pharmacy to be destroyed.</span></span></div><div style="background-color: white; line-height: 16.7999992370605px; margin-bottom: 1.3em; margin-top: 1.3em;"><span style="font-family: Verdana, sans-serif;">Dr. David Juurlink, head of clinical pharmacology and toxicology at Sunnybrook Health Sciences Centre in Toronto, said concerns about diminished potency depends on the drug and how much time has elapsed since the best-before date.</span></div><span style="font-family: Verdana, sans-serif;"><i>“For most drugs, the passage of a short amount of time after the expiry date is really of little clinical consequence,”</i> he said. <i>“In general, something that’s six to 12 months past the expiry date, with rare exceptions, is not going to be a problem at all. They’re not going to be dangerous.”</i><br />
<br />
A 2012 study of a small number of drugs—some of them bottled or packaged 40 years earlier—found that active ingredients did degrade over time, but some more than others. For instance, researchers found ASA pills dropped in strength from 200 milligrams to two milligrams, while codeine barely lost any of its chemical constituents.</span><br /><br />
<span style="font-family: Verdana, sans-serif;"><br /></span><br />
<span style="background-color: white; line-height: 16.7999992370605px;"><span style="font-family: Verdana, sans-serif;"><i>“It’s not like milk, and it’s not as though something magical happened on the expiry date and the drug loses all of its potency,” </i>Juurlink said. <i>“With most, but not all, it’s probably safe to take drugs that have expired recently. But the more time that has elapsed from the expiry date, the less advisable it becomes.”</i></span></span><br /><br />
<span style="font-family: Verdana, sans-serif;"><br /></span><br />
<span style="font-family: Verdana, sans-serif;">Link to full article: <b><a href="http://www.canadianhealthcarenetwork.ca/pharmacists/news/drug-news/medications-past-best-before-date-may-lose-potency-but-how-soon-30927?utm_source=EmailMarketing" target="_blank">click here</a></b></span>cralphhttp://www.blogger.com/profile/17716398305539789239noreply@blogger.com0tag:blogger.com,1999:blog-3348564512398570082.post-4745529678541765492015-04-07T12:02:00.001-06:002015-04-08T09:38:40.604-06:00Opioid Tapering Guidelines<a href="http://nationalpaincentre.mcmaster.ca/opioid/cgop_b_app_b12.html">McMaster University > Michael G. DeGroote National Pain Centre > Canadian Guideline for Opioid Use for Pain — Appendix B-12: Opioid Tapering</a>:<br />
<br />
"Rate of the Taper<br />
The <b>rate of the taper</b> can vary from 10% of the total daily dose every day, to 10% of the total daily dose every 1–2 weeks.<br />
<ul>
<li>Slower tapers are recommended for patients who are anxious about tapering, may be psychologically dependent on opioids, have co-morbid cardio-respiratory conditions, or express a preference for a slow taper. </li>
<li>Once one-third of the original dose is reached, slow the taper to one-half or less of the previous rate.</li>
<li>Hold [or increase] the dose when appropriate: </li>
<li>The dose should be held or increased if the patient experiences severe withdrawal symptoms, a significant worsening of pain or mood, or reduced function during the taper."</li>
</ul>
Click here for link to the <a href="http://nationalpaincentre.mcmaster.ca/opioid/cgop_b_app_b12.html" target="_blank">article</a>cralphhttp://www.blogger.com/profile/17716398305539789239noreply@blogger.com0tag:blogger.com,1999:blog-3348564512398570082.post-47495528786452271732015-04-07T11:39:00.000-06:002015-04-07T11:39:26.981-06:00eLearning: Lancet Oncology Podcasts<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiLWOsLylEkibP2YJ9-h1ioISKHm27lLKk2xizKuhEi-ucYJK5-5a1thULSKkss2HGcjleIWtzZvCfKxERxunfEg3emxzexA4ZuQldZLWNpMdXIH7-74T0-q6jemDodyZ4MhU5G2UbUH5lK/s1600/lancet.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiLWOsLylEkibP2YJ9-h1ioISKHm27lLKk2xizKuhEi-ucYJK5-5a1thULSKkss2HGcjleIWtzZvCfKxERxunfEg3emxzexA4ZuQldZLWNpMdXIH7-74T0-q6jemDodyZ4MhU5G2UbUH5lK/s1600/lancet.png" /></a></div>
<br />
<b><a href="http://www.thelancet.com/audio?filterModify=true&journalFilter=lanonc" target="_blank">Lancet Oncology </a></b>produces podcasts - the frequency looks to be about every 2 to 4 weeks.<br />
<br />
<b><a href="http://www.thelancet.com/audio?filterModify=true&journalFilter=lanonc" target="_blank">Click here</a></b> for the link and learn while you're on the go.<br />
<br />
Please share in the comments section below any oncology or palliative related podcasts that you find helpful or Tweet me <a href="http://twitter.com/oncoprn" target="_blank">@OncoPRN</a>.cralphhttp://www.blogger.com/profile/17716398305539789239noreply@blogger.com0tag:blogger.com,1999:blog-3348564512398570082.post-76946974130685928552015-01-19T13:56:00.000-07:002015-01-22T13:08:59.919-07:00"Palliative Care" - The Words We Use Via <b><a href="http://pallium.ca/the-words-we-use/" target="_blank">Pallium Canada</a></b>, who have been producing a great series of videos helping to bridge the gap with respect to some of the misconceptions surrounding palliative care.<br />
<span style="font-family: inherit;"><br /></span>
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<div style="background-color: white; font-size: 14px; line-height: 20px; margin-bottom: 20px;">
<span style="font-family: inherit;"><i>"Supportive Care…Supportive Oncology…The Comfort Team…The Butterfly Team (as may be heard in pediatrics)…</i></span></div>
<div style="background-color: white; font-size: 14px; line-height: 20px; margin-bottom: 20px;">
<span style="font-family: inherit;"><i>Why is there so much resistance to the use of the “P” word – palliative? The truth is, palliative care might not be what many people think it is.</i></span></div>
<div style="background-color: white; font-size: 14px; line-height: 20px; margin-bottom: 20px;">
<span style="font-family: inherit;"><i>Language provides us with a tapestry of tools for communication and understanding. In palliative care, the use of poetic license is certainly no less than in any other fields of medicine. However, the words we use can be confusing."</i></span></div>
<br />
<iframe width="560" height="315" src="//www.youtube.com/embed/zFvSgEKJktY" frameborder="0" allowfullscreen></iframe>
<br />
Choose your words wisely...<br />
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</div>cralphhttp://www.blogger.com/profile/17716398305539789239noreply@blogger.com0tag:blogger.com,1999:blog-3348564512398570082.post-54896579331065232982014-08-03T12:38:00.001-06:002015-01-19T13:56:53.917-07:00Palliative Care: Better Early Than Late The much referred to <a href="http://connection.asco.org/forums/forumid/4/threadid/64/scope/posts.aspx" target="_blank">NEJM Temel article </a>highlighted the positive impact of early palliative care in terms of symptom management and even extending life. The Pallium group summarize this nicely:<br />
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<iframe allowfullscreen="" frameborder="0" height="315" src="//www.youtube.com/embed/-SzA-kWB8-s" width="560"></iframe>cralphhttp://www.blogger.com/profile/17716398305539789239noreply@blogger.com0tag:blogger.com,1999:blog-3348564512398570082.post-66507799754303464202014-05-05T09:34:00.001-06:002014-05-05T09:36:12.223-06:00Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers: ASCO Clinical Practice Guideline<div style="text-align: right;">
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ASCO has recently published guidelines for the <a class="zem_slink" href="http://en.wikipedia.org/wiki/Preventive_medicine" rel="wikipedia" target="_blank" title="Preventive medicine">prevention</a> and management of <a class="zem_slink" href="http://en.wikipedia.org/wiki/Cancer_pain" rel="wikipedia" target="_blank" title="Cancer pain">CIPN</a>. Unfortunately, but not surprisingly even after a robust <a class="zem_slink" href="http://en.wikipedia.org/wiki/Medical_literature" rel="wikipedia" target="_blank" title="Medical literature">medical literature</a> search, there are no revolutionary breakthroughs for the treatment or prevention of chemotherapy-induced <a class="zem_slink" href="http://en.wikipedia.org/wiki/Peripheral_neuropathy" rel="wikipedia" target="_blank" title="Peripheral neuropathy">neuropathy</a> (CIPN). Here is a summary of the publication:<br />
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<div style="text-align: center;">
<b>[You will also find this web page linked on the left hand side permanently under "<i>Useful Links</i>"]</b></div>
<blockquote class="tr_bq">
<b>"Recommendations: </b>On the basis of the paucity of high-quality, consistent evidence, there are no agents recommended for the prevention of CIPN. With regard to the treatment of existing CIPN, the best available data support a moderate recommendation for treatment with <b>duloxetine</b>. Although the CIPN trials are inconclusive regarding <a class="zem_slink" href="http://en.wikipedia.org/wiki/Tricyclic_antidepressant" rel="wikipedia" target="_blank" title="Tricyclic antidepressant">tricyclic antidepressants</a> (such as <a class="zem_slink" href="http://en.wikipedia.org/wiki/Nortriptyline" rel="wikipedia" target="_blank" title="Nortriptyline">nortriptyline</a>), gabapentin, and a compounded topical gel containing baclofen, amitriptyline HCL, and ketamine, these agents may be offered on the basis of data supporting their utility in other <a class="zem_slink" href="http://en.wikipedia.org/wiki/Neuropathic_pain" rel="wikipedia" target="_blank" title="Neuropathic pain">neuropathic pain</a> conditions given the limited other CIPN treatment options. Further research on these agents is warranted."</blockquote>
Link to the guidelines, summary, slide deck, etc. at ASCO website: <b><a href="http://www.asco.org/prevention-and-management-chemotherapy-induced-peripheral-neuropathy-survivors-adult-cancers" target="_blank">click here</a></b><br />
<br />
<a href="http://www.asco.org/prevention-and-management-chemotherapy-induced-peripheral-neuropathy-survivors-adult-cancers">Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline | ASCO.org</a><br />
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cralphhttp://www.blogger.com/profile/17716398305539789239noreply@blogger.com0tag:blogger.com,1999:blog-3348564512398570082.post-32811956482058962512014-04-13T13:04:00.001-06:002014-04-13T13:08:26.242-06:00"Cancer: The Emperor of All Maladies" Preview at AACR Annual Meeting 2014<div style="text-align: right;">
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"The <a class="zem_slink" href="http://www.aacr.org/" rel="homepage" title="American Association for Cancer Research">American Association for Cancer Research</a> (AACR), the world's oldest and largest <a class="zem_slink" href="http://en.wikipedia.org/wiki/Professional_association" rel="wikipedia" title="Professional association">professional organization</a> dedicated to advancing <a class="zem_slink" href="http://en.wikipedia.org/wiki/Cancer" rel="wikipedia" title="Cancer">cancer</a> research and its mission to prevent and cure cancer, is proud to be an outreach partner for "CANCER: The Emperor of All Maladies," a <a class="zem_slink" href="http://en.wikipedia.org/wiki/Documentary_film" rel="wikipedia" title="Documentary film">film documentary</a> presented by <a class="zem_slink" href="http://twitter.com/kenburns" rel="twitter" title="Ken Burns">Ken Burns</a>. Based on the book "<a class="zem_slink" href="http://en.wikipedia.org/wiki/The_Emperor_of_All_Maladies%3A_A_Biography_of_Cancer" rel="wikipedia" title="The Emperor of All Maladies: A Biography of Cancer">The Emperor of All Maladies: A Biography of Cancer</a>" by <a class="zem_slink" href="http://en.wikipedia.org/wiki/Siddhartha_Mukherjee" rel="wikipedia" title="Siddhartha Mukherjee">Siddhartha Mukherjee</a>, M.D., the film will air on <a class="zem_slink" href="http://pbs.org/" rel="homepage" title="PBS">PBS</a> in spring 2015. The AACR is an outreach partner for the documentary, along with <a class="zem_slink" href="http://en.wikipedia.org/wiki/Stand_Up_to_Cancer" rel="wikipedia" title="Stand Up to Cancer">Stand Up To Cancer</a> (SU2C), a program of the <a class="zem_slink" href="http://en.wikipedia.org/wiki/Entertainment_Industry_Foundation" rel="wikipedia" title="Entertainment Industry Foundation">Entertainment Industry Foundation</a> (EIF) that works to accelerate innovative cancer research and to increase awareness about progress being made in the fight against the disease."<iframe allowfullscreen="" frameborder="0" height="270" src="//www.youtube.com/embed/e4amVPhuQac" width="480"></iframe><br />
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cralphhttp://www.blogger.com/profile/17716398305539789239noreply@blogger.com0tag:blogger.com,1999:blog-3348564512398570082.post-26274560782600385142014-03-22T11:13:00.001-06:002014-03-22T11:16:00.781-06:00Video: Healthcare Professionals on Twitter: Worldwide Growth Mapped 2006-2014"Video maps growth in doctors, nurses and <a class="zem_slink" href="http://en.wikipedia.org/wiki/Health_care_provider" rel="wikipedia" title="Health care provider">healthcare professionals</a> using <a class="zem_slink" href="http://twitter.com/" rel="homepage" title="Twitter">Twitter</a> since its launch in 2006 to 2014. Data sourced using Creation Pinpoint, the world's largest research tool for learning from healthcare professionals in public social media."<br />
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cralphhttp://www.blogger.com/profile/17716398305539789239noreply@blogger.com0tag:blogger.com,1999:blog-3348564512398570082.post-43151053667334661172014-03-19T10:09:00.003-06:002014-03-19T10:09:41.203-06:00Valproic Acid Linked with Reduced Risk of Developing Head and Neck Cancer<table cellpadding="0" cellspacing="0" class="tr-caption-container zemanta-img" style="float: right; margin-right: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="http://commons.wikipedia.org/wiki/File:Sodium-valproate-2D-skeletal.png" imageanchor="1" style="margin-bottom: 1em; margin-left: auto; margin-right: auto; text-align: clear:right;"><img alt="Sodium valproate is a common mood stabilizer" border="0" class="zemanta-img-inserted zemanta-img-configured" height="143" src="http://upload.wikimedia.org/wikipedia/commons/thumb/3/36/Sodium-valproate-2D-skeletal.png/350px-Sodium-valproate-2D-skeletal.png" style="border: none; font-size: 0.8em;" width="200" /></a></td></tr>
<tr><td class="tr-caption zemanta-img-attribution" style="text-align: center; width: 350px;">Sodium valproate is a common mood stabilizer (Photo credit: <a href="http://commons.wikipedia.org/wiki/File:Sodium-valproate-2D-skeletal.png">Wikipedia</a>)</td></tr>
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<span style="font-family: inherit; font-size: small;">I was surprised to read this press release this morning concerning valproic acid, an antiepileptic, <a class="zem_slink" href="http://en.wikipedia.org/wiki/Mood_stabilizer" rel="wikipedia" title="Mood stabilizer">mood stabilizing medication</a> that has also been used traditionally in the management of neuropathic pain.</span></div>
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<span style="font-family: inherit; font-size: small;"><br /></span></div>
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<span style="font-family: inherit; font-size: small;">I am interesting in seeing the doses most commonly encountered and the relevant toxicities. As PCF-4 (<a href="http://palliativedrugs.org/">PalliativeDrugs.org</a>) notes, no single mode of action accounts for its anti-seizure activity. It is a:</span></div>
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<ul>
<li><span style="color: #222222; font-family: inherit;">sodium and T-type calcium channel blocker</span></li>
<li><span style="color: #222222; font-family: inherit;">an <a class="zem_slink" href="http://en.wikipedia.org/wiki/NMDA_receptor" rel="wikipedia" title="NMDA receptor">NMDA receptor</a>-channel blocker (?helpful in hyperalgesia)</span></li>
<li><span style="color: #222222; font-family: inherit;">alters GABA (distinctively selective for midbrain), dopamine and serotonin transmission</span></li>
</ul>
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<span style="color: #222222;"><span style="font-family: inherit;">T-type calcium channels have been implicated in thalamic burst firing (absence seizures), neuropathic pain and possibly in regulating pain excitation thresholds in a 'T-rich' subset of peripheral nociceptors. </span></span></div>
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<span style="font-family: inherit;">Beneficial effects have been reports in cancer-related neuropathic pain in Europe and Australia, but mixed results in other pain scenarios. Onset of action can often be within 24 hours for neuropathic pain.</span></div>
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<span style="font-family: inherit;"><br /></span></div>
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<span style="font-family: inherit;">But I digress - on to the news of the day:</span></div>
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<span style="font-family: inherit; font-size: small;"><i>Excerpt of Press Release via <a href="http://ca.wiley.com/WileyCDA/Section/id-397743,view-journal,journalCd-CNCR.html?dmmsmid=83556&dmmspid=23412570&dmmsuid=2211462" target="_blank">Wiley</a>:</i></span></div>
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<span style="font-family: inherit; font-size: small;">"A new study indicates that a commonly used mood stabilizing drug may help prevent head and neck cancer. The study is published early online in <i><a href="http://dmmsclick.wiley.com/click.asp?p=23412570&m=83556&u=2211464" style="color: #1155cc;" target="_blank">CANCER</a></i>, a peer-reviewed journal of the <a class="zem_slink" href="http://www.cancer.org/" rel="homepage" title="American Cancer Society">American Cancer Society</a>.</span></div>
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<span style="font-family: inherit; font-size: small;">Valproic acid (VPA) is currently prescribed as an anti-seizure medication and mood stabilizer, but it is also being <i>studied as an anticancer agent because it inhibits histone acetyl transferases, which help control gene expression by changing <a class="zem_slink" href="http://en.wikipedia.org/wiki/Nucleic_acid_structure" rel="wikipedia" title="Nucleic acid structure">DNA structure</a>.</i></span></div>
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<span style="font-family: inherit; font-size: small;">Johann Christoph Brandes MD, <a class="zem_slink" href="http://en.wikipedia.org/wiki/Doctor_of_Philosophy" rel="wikipedia" title="Doctor of Philosophy">PhD</a>, of the Atlanta <a class="zem_slink" href="http://maps.google.com/maps?ll=38.9009027778,-77.0348238889&spn=0.01,0.01&q=38.9009027778,-77.0348238889%20(Veterans%20Health%20Administration)&t=h" rel="geolocation" title="Veterans Health Administration">Veterans Affairs Medical Center</a> and <a class="zem_slink" href="http://maps.google.com/maps?ll=33.7911111111,-84.3233333333&spn=0.01,0.01&q=33.7911111111,-84.3233333333%20(Emory%20University)&t=h" rel="geolocation" title="Emory University">Emory University</a> in Atlanta, led a team that assessed the anticancer effects of VPA in a study of 439,628 veterans, of whom 26,911 were taking the medication for bipolar disorder, post-traumatic stress disorder, migraines, and seizures.</span></div>
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<span style="font-family: inherit; font-size: small;">Veterans who took VPA for at least one year had a 34 percent lower risk of developing head and neck cancer compared with those who did not take the medication. Higher doses and longer duration of VPA use seemed to provide additional benefits. No significant differences were observed for lung, bladder, colon, and prostate cancer incidences.</span></div>
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<span style="font-family: inherit; font-size: small;">“A 34 percent risk reduction for the development of head and neck cancer with VPA use could result in the prevention of up to approximately 16,000 new cases and 3,000 to 4,000 annual deaths in the US alone,” said Dr. Brandes. “<a class="zem_slink" href="http://en.wikipedia.org/wiki/Head_and_neck_cancer" rel="wikipedia" title="Head and neck cancer">Head and neck cancer</a> is an important global health crisis, and low cost and low toxicity prevention strategies like VPA use have a high potential impact on pain, suffering, costs, and mortality associated with this disease.”</span></div>
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<span style="font-family: inherit; font-size: x-small;"><b><u>Article: </u></b>“Long-term use of valproic acid in <a class="zem_slink" href="http://maps.google.com/maps?ll=38.8833333333,-77.0166666667&spn=10.0,10.0&q=38.8833333333,-77.0166666667%20(United%20States)&t=h" rel="geolocation" title="United States">United States</a> Veterans associates with reduced risk of smoking related head-and neck cancer.” Hyunseok Kang, Theresa Gillespie, Michael Goodman, Seth Brodie, Mina Brandes, <a class="zem_slink" href="http://en.wikipedia.org/wiki/Maria_Ribeiro" rel="wikipedia" title="Maria Ribeiro">Maria Ribeiro</a>, Suresh Ramalingam, Dong Shin, Fadlo Khuri, and Johann Christoph Brandes. CANCER; Published Online: <span class="aBn" data-term="goog_666802659" style="border-bottom-color: rgb(204, 204, 204); border-bottom-style: dashed; border-bottom-width: 1px; position: relative; top: -2px; z-index: 0;" tabindex="0"><span class="aQJ" style="position: relative; top: 2px; z-index: -1;"><b>March 24, 2014</b></span></span> (DOI: 10.1002/cncr.28479).</span></div>
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<span style="font-family: inherit; font-size: x-small;"><b><u>URL Upon Publication:</u></b> <a href="http://dmmsclick.wiley.com/click.asp?p=23412570&m=83556&u=2211468" style="color: #1155cc;" target="_blank">http://doi.wiley.com/10.1002/<wbr></wbr>cncr.28479</a></span></div>
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cralphhttp://www.blogger.com/profile/17716398305539789239noreply@blogger.com0tag:blogger.com,1999:blog-3348564512398570082.post-87988277748996979072014-03-18T09:55:00.001-06:002014-03-18T09:58:11.758-06:00Treating ‘phantom limb pain’ with mirror therapy - Mirror Box Therapy<table cellpadding="0" cellspacing="0" class="tr-caption-container zemanta-img" style="float: right; margin-right: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="http://commons.wikipedia.org/wiki/File:Ramachandran-mirrorbox.svg" imageanchor="1" style="margin-bottom: 1em; margin-left: auto; margin-right: auto; text-align: clear:right;"><img alt="A mirror box used for treating phantom limbs, ..." border="0" class="zemanta-img-inserted zemanta-img-configured" height="216" src="http://upload.wikimedia.org/wikipedia/commons/thumb/4/41/Ramachandran-mirrorbox.svg/350px-Ramachandran-mirrorbox.svg.png" style="border: none; font-size: 0.8em;" width="350" /></a></td></tr>
<tr><td class="tr-caption zemanta-img-attribution" style="text-align: center; width: 350px;">A mirror box used for treating phantom limbs, developed by V.S. Ramachandran. (Photo credit: <a href="http://commons.wikipedia.org/wiki/File:Ramachandran-mirrorbox.svg">Wikipedia</a>)</td></tr>
</tbody></table>
<a href="http://www.ireflex.co.uk/mirrorboxtherapy.com/treating-phantom-limb-pain-with-mirror-therapy/">Treating ‘phantom limb pain’ with mirror therapy | mirror box therapy</a>:<br />
<br />
"Whether the phantom is in the hand or the foot the principle of mirror box therapy is still the same. In this video soldier Bryan Wagner talk us through his phantom and how mirror box therapy help him cope with the pain."<br />
<br />
<a href="http://www.ireflex.co.uk/mirrorboxtherapy.com/treating-phantom-limb-pain-with-mirror-therapy/" target="_blank"><span style="font-size: x-small;">L</span>ink to full article and video</a><br />
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cralphhttp://www.blogger.com/profile/17716398305539789239noreply@blogger.com0tag:blogger.com,1999:blog-3348564512398570082.post-48849826467945119792014-03-03T09:32:00.001-07:002014-03-03T09:34:00.785-07:00The WPCA - Global Atlas of Palliative Care<span style="font-family: inherit;"><a href="http://www.thewpca.org/resources/global-atlas-of-palliative-care/">The WPCA - Global Atlas of Palliative Care</a>: </span><br />
<br />
<span style="font-family: inherit;">"Published jointly by the <a class="zem_slink" href="http://www.who.int/" rel="homepage" target="_blank" title="World Health Organization">World Health Organization</a> and the Worldwide Palliative Care Alliance, the Atlas is the first document to map the need for and availability of palliative care globally.<br />
<br />
Using maps, graphs and <a class="zem_slink" href="http://en.wikipedia.org/wiki/Case_study" rel="wikipedia" target="_blank" title="Case study">case studies</a>, and drawing on a wealth of resources, the Atlas addresses <span style="background-color: white;">the following questions:</span></span><br />
<br />
<ul style="background-color: white; margin: 0px 0px 0px 0em; padding: 0px 0px 0px 0em;">
<li style="background-image: url(http://www.thewpca.org/EasySiteWeb/EasySite/StyleData/WPCA_Master/Images/bullet.gif); background-position: 0% 0.3em; background-repeat: no-repeat no-repeat; list-style-type: none; padding-left: 1.1em;"><span style="font-family: inherit;">What is palliative care?</span></li>
</ul>
<ul style="background-color: white; margin: 0px 0px 0px 0em; padding: 0px 0px 0px 0em;">
<li style="background-image: url(http://www.thewpca.org/EasySiteWeb/EasySite/StyleData/WPCA_Master/Images/bullet.gif); background-position: 0% 0.3em; background-repeat: no-repeat no-repeat; list-style-type: none; padding-left: 1.1em;"><span style="font-family: inherit;">Why is palliative care a human <a class="zem_slink" href="http://en.wikipedia.org/wiki/Rights_issue" rel="wikipedia" target="_blank" title="Rights issue">rights issue</a>?</span></li>
</ul>
<ul style="background-color: white; margin: 0px 0px 0px 0em; padding: 0px 0px 0px 0em;">
<li style="background-image: url(http://www.thewpca.org/EasySiteWeb/EasySite/StyleData/WPCA_Master/Images/bullet.gif); background-position: 0% 0.3em; background-repeat: no-repeat no-repeat; list-style-type: none; padding-left: 1.1em;"><span style="font-family: inherit;">What are the main diseases requiring palliative care?</span></li>
</ul>
<ul style="background-color: white; margin: 0px 0px 0px 0em; padding: 0px 0px 0px 0em;">
<li style="background-image: url(http://www.thewpca.org/EasySiteWeb/EasySite/StyleData/WPCA_Master/Images/bullet.gif); background-position: 0% 0.3em; background-repeat: no-repeat no-repeat; list-style-type: none; padding-left: 1.1em;"><span style="font-family: inherit;">What is the need for palliative care?</span></li>
</ul>
<ul style="background-color: white; margin: 0px 0px 0px 0em; padding: 0px 0px 0px 0em;">
<li style="background-image: url(http://www.thewpca.org/EasySiteWeb/EasySite/StyleData/WPCA_Master/Images/bullet.gif); background-position: 0% 0.3em; background-repeat: no-repeat no-repeat; list-style-type: none; padding-left: 1.1em;"><span style="font-family: inherit;">What are the barriers to palliative care?</span></li>
</ul>
<ul style="background-color: white; margin: 0px 0px 0px 0em; padding: 0px 0px 0px 0em;">
<li style="background-image: url(http://www.thewpca.org/EasySiteWeb/EasySite/StyleData/WPCA_Master/Images/bullet.gif); background-position: 0% 0.3em; background-repeat: no-repeat no-repeat; list-style-type: none; padding-left: 1.1em;"><span style="font-family: inherit;">Where is palliative care currently available?</span></li>
</ul>
<ul style="background-color: white; margin: 0px 0px 0px 0em; padding: 0px 0px 0px 0em;">
<li style="background-image: url(http://www.thewpca.org/EasySiteWeb/EasySite/StyleData/WPCA_Master/Images/bullet.gif); background-position: 0% 0.3em; background-repeat: no-repeat no-repeat; list-style-type: none; padding-left: 1.1em;"><span style="font-family: inherit;">What are the models of palliative care worldwide?</span></li>
</ul>
<ul style="background-color: white; margin: 0px 0px 0px 0em; padding: 0px 0px 0px 0em;">
<li style="background-image: url(http://www.thewpca.org/EasySiteWeb/EasySite/StyleData/WPCA_Master/Images/bullet.gif); background-position: 0% 0.3em; background-repeat: no-repeat no-repeat; list-style-type: none; padding-left: 1.1em;"><span style="font-family: inherit;">What resources are devoted to palliative care?</span></li>
<li style="background-image: url(http://www.thewpca.org/EasySiteWeb/EasySite/StyleData/WPCA_Master/Images/bullet.gif); background-position: 0% 0.3em; background-repeat: no-repeat no-repeat; list-style-type: none; padding-left: 1.1em;"><span style="font-family: inherit;">What is the way forward"</span></li>
</ul>
<br />
<span style="font-family: inherit;"><br /></span>
<u><a href="http://www.thewpca.org/resources/global-atlas-of-palliative-care/" target="_blank">Read the full article here</a></u><br />
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cralphhttp://www.blogger.com/profile/17716398305539789239noreply@blogger.com0tag:blogger.com,1999:blog-3348564512398570082.post-14555119677745208452014-02-25T11:55:00.001-07:002014-03-03T09:36:06.898-07:00VTE Treatment and Secondary Prevention in Cancer Patients<span style="font-family: inherit;"><a href="https://www.cancerthrombosis.org/moduleArticle?id=5">CancerThrombosis.org :: Treatment and Secondary Prevention</a>: </span><br />
<blockquote class="tr_bq">
<span style="font-family: inherit;"><i>"The <a class="zem_slink" href="http://www.asco.org/" rel="homepage" target="_blank" title="American Society of Clinical Oncology">American Society of Clinical Oncology</a> guideline: Recommendations for venous thromboembolism prophylaxis and treatment in <a class="zem_slink" href="http://en.wikipedia.org/wiki/Patient" rel="wikipedia" target="_blank" title="Patient">patients</a> with cancer<br />
Key recommendations for secondary prevention of recurrent VTE19"</i></span></blockquote>
<br />
<ul style="background-color: #e9e8e8; color: #333333; font-size: 11px; line-height: 19.799999237060547px; list-style: square; margin: 0px; padding: 0px 0px 0px 15px;">
<li style="margin: 0px; padding: 0px;"><span style="font-family: inherit;"><a class="zem_slink" href="http://en.wikipedia.org/wiki/Low_molecular_weight_heparin" rel="wikipedia" target="_blank" title="Low molecular weight heparin">LMWH</a> is the preferred approach for the initial 5 to 10 days of anticoagulant treatment of the <a class="zem_slink" href="http://en.wikipedia.org/wiki/Cancer" rel="wikipedia" target="_blank" title="Cancer">cancer patient</a> with established VTE</span></li>
</ul>
<ul style="background-color: #e9e8e8; color: #333333; font-size: 11px; line-height: 19.799999237060547px; list-style: square; margin: 0px; padding: 0px 0px 0px 15px;">
<li style="margin: 0px; padding: 0px;"><span style="font-family: inherit;">LMWH given for 6 months is also the preferred approach for long-term <a class="zem_slink" href="http://en.wikipedia.org/wiki/Anticoagulant" rel="wikipedia" target="_blank" title="Anticoagulant">anticoagulant therapy</a>. Vitamin K antagonists with a targeted INR of 2 to 3 are acceptable for long-term therapy when LMWH is not available</span></li>
</ul>
<ul style="background-color: #e9e8e8; color: #333333; font-size: 11px; line-height: 19.799999237060547px; list-style: square; margin: 0px; padding: 0px 0px 0px 15px;">
<li style="margin: 0px; padding: 0px;"><span style="font-family: inherit;">After 6 months, indefinite anticoagulant therapy should be considered for selected patients with active cancer, such as those with metastatic disease and those receiving chemotherapy</span></li>
</ul>
<ul style="background-color: #e9e8e8; color: #333333; font-size: 11px; line-height: 19.799999237060547px; list-style: square; margin: 0px; padding: 0px 0px 0px 15px;">
<li style="margin: 0px; padding: 0px;"><span style="font-family: inherit;">The insertion of a <a class="zem_slink" href="http://en.wikipedia.org/wiki/Inferior_vena_cava_filter" rel="wikipedia" target="_blank" title="Inferior vena cava filter">vena cava filter</a> is only indicated for patients with contraindications to anticoagulant therapy and in those with recurrent VTE despite adequate long-term therapy with LMWH</span></li>
</ul>
<ul style="background-color: #e9e8e8; color: #333333; font-size: 11px; line-height: 19.799999237060547px; list-style: square; margin: 0px; padding: 0px 0px 0px 15px;">
<li style="margin: 0px; padding: 0px;"><span style="font-family: inherit;">For patients with <a class="zem_slink" href="http://en.wikipedia.org/wiki/Central_nervous_system" rel="wikipedia" target="_blank" title="Central nervous system">CNS</a> malignancies, anticoagulation is recommended for established VTE as described for other patients with cancer. Careful monitoring is necessary to limit the risk of <a class="zem_slink" href="http://en.wikipedia.org/wiki/Bleeding" rel="wikipedia" target="_blank" title="Bleeding">hemorrhagic</a> complications. Anticoagulation should be avoided in the presence of active intracranial bleeding, recent surgery, preexisting <a class="zem_slink" href="http://en.wikipedia.org/wiki/Bleeding_diathesis" rel="wikipedia" target="_blank" title="Bleeding diathesis">bleeding diathesis</a> such as thrombocytopenia (platelet count <50 coagulopathy="" font="" l="" or=""></50></span></li>
</ul>
<ul style="background-color: #e9e8e8; color: #333333; font-size: 11px; line-height: 19.799999237060547px; list-style: square; margin: 0px; padding: 0px 0px 0px 15px;">
<li style="margin: 0px; padding: 0px;"><span style="font-family: inherit;">For elderly patients, anticoagulation is recommended for established VTE as described for other patients with cancer. Careful monitoring and dose adjustment is necessary to avoid excessive anticoagulation and further increase in the risk of bleeding</span></li>
</ul>
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<span style="font-family: inherit;"><br /></span>
<span style="font-family: inherit;"><a href="https://chrome.google.com/webstore/detail/pengoopmcjnbflcjbmoeodbmoflcgjlk" style="font-size: 13px;">F</a>or full article including great summary charts and diagrams as well as other key player guidelines, <a href="https://www.cancerthrombosis.org/moduleArticle?id=5" target="_blank">click here</a>.</span><br />
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cralphhttp://www.blogger.com/profile/17716398305539789239noreply@blogger.com0tag:blogger.com,1999:blog-3348564512398570082.post-79289952481959270092014-02-22T16:14:00.001-07:002014-02-22T16:15:40.943-07:00Personalized Cancer Treament, From Just a Blood Sample<a href="http://blogs.discovermagazine.com/crux/2014/02/21/personalized-cancer-treament-from-just-a-blood-sample/#.UwkvJEJdWEj">Personalized Cancer Treament, From Just a Blood Sample - The Crux | DiscoverMagazine.com</a>:<br />
<br />
<br />
<br />
"A technique being developed by San Diego–based <a class="zem_slink" href="http://www.epicsciences.com/" rel="homepage" title="Epic Sciences">Epic Sciences</a> can determine whether a cancer patient is an appropriate candidate for a drug, and even whether the drug is losing its efficacy.<br />
<br />
In research presented last month at the Personalized Medicine World Conference in <a class="zem_slink" href="http://maps.google.com/maps?ll=37.4291666667,-122.138055556&spn=0.1,0.1&q=37.4291666667,-122.138055556%20(Palo%20Alto%2C%20California)&t=h" rel="geolocation" title="Palo Alto, California">Palo Alto, CA</a>, Epic described how their technology can be used to reliably pick out rare cells from a blood sample. In the case of cancer, these rare, <a class="zem_slink" href="http://en.wikipedia.org/wiki/Circulating_tumor_cell" rel="wikipedia" title="Circulating tumor cell">circulating tumor cells</a> could one day tell an oncologist not only whether a patient’s cancer has returned, but also whether it’s growing resistant to the current treatment regimen—something only expensive scans and invasive biopsies can do with any accuracy today."<br />
<br />
<br />
<br />
<u>Read the full article <a href="http://blogs.discovermagazine.com/crux/2014/02/21/personalized-cancer-treament-from-just-a-blood-sample/#.UwkvJEJdWEj" target="_blank">here</a></u><br />
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cralphhttp://www.blogger.com/profile/17716398305539789239noreply@blogger.com0tag:blogger.com,1999:blog-3348564512398570082.post-48002923107560492452014-02-13T14:28:00.001-07:002014-02-13T14:30:49.037-07:00Medications Can Affect Sexes Differently<table cellpadding="0" cellspacing="0" class="tr-caption-container zemanta-img" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://commons.wikipedia.org/wiki/File:Zolpidem_structure_simple.svg" imageanchor="1" style="margin-bottom: 1em; margin-left: auto; margin-right: auto; text-align: clear:right;"><img alt="English: Chemical structure of zolpidem" border="0" class="zemanta-img-inserted zemanta-img-configured" height="224" src="http://upload.wikimedia.org/wikipedia/commons/thumb/2/20/Zolpidem_structure_simple.svg/350px-Zolpidem_structure_simple.svg.png" style="border: none; font-size: 0.8em;" width="350" /></a></td></tr>
<tr><td class="tr-caption zemanta-img-attribution" style="text-align: center; width: 350px;">English: Chemical structure of zolpidem (Photo credit: <a href="http://commons.wikipedia.org/wiki/File:Zolpidem_structure_simple.svg">Wikipedia</a>)</td></tr>
</tbody></table>
<a href="http://www.cbsnews.com/news/sex-matters-drugs-can-affect-sexes-differently/">Sex matters: Drugs can affect sexes differently - CBS News</a>:<br />
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<br />
"Ambien, <a class="zem_slink" href="http://en.wikipedia.org/wiki/Zolpidem" rel="wikipedia" title="Zolpidem">Zolpidem</a>, is now the only <a class="zem_slink" href="http://en.wikipedia.org/wiki/Prescription_drug" rel="wikipedia" title="Prescription drug">prescription drug</a> in the country with a different suggested dose for men and women. But we’ve discovered it is far from an isolated example of differences between the sexes we never imagined. More and more, scientists are realizing that the differences are dangerously understudied and that pervasively and fundamentally, sex matters.<br />
Take aspirin. <a class="zem_slink" href="http://en.wikipedia.org/wiki/Aspirin" rel="wikipedia" title="Aspirin">Low-dose aspirin</a> lowers the risk of <a class="zem_slink" href="http://en.wikipedia.org/wiki/Myocardial_infarction" rel="wikipedia" title="Myocardial infarction">heart attacks</a> in healthy men; but in healthy women, turns out it doesn’t though it does protect women against stroke.<br />
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And drugs are just the beginning. <a class="zem_slink" href="http://en.wikipedia.org/wiki/Sexual_dimorphism" rel="wikipedia" title="Sexual dimorphism">Sex differences</a> have been found in pain receptors, <a class="zem_slink" href="http://en.wikipedia.org/wiki/Liver_function_tests" rel="wikipedia" title="Liver function tests">liver enzymes</a>, even the wiring of the brain."<br />
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<a href="https://chrome.google.com/webstore/detail/pengoopmcjnbflcjbmoeodbmoflcgjlk" style="font-size: 13px;">R</a>ead full article: <a href="http://www.cbsnews.com/news/sex-matters-drugs-can-affect-sexes-differently/" target="_blank">click here</a><br />
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cralphhttp://www.blogger.com/profile/17716398305539789239noreply@blogger.com0tag:blogger.com,1999:blog-3348564512398570082.post-3185407754334873402014-02-09T17:10:00.001-07:002014-02-09T17:11:28.069-07:00Could Electronically Controlled Drugs Reduce Adverse Effects? (CNET)<a href="http://news.cnet.com/8301-11386_3-57618425-76/could-electronically-controlled-drugs-reduce-side-effects/?ttag=fbwl">Could electronically controlled drugs reduce side effects? | Cutting Edge - CNET News</a>:<br />
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In the realm of oncology this could have especially dramatic ramifications.<br />
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Excerpt:<br />
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<i><br /></i>
<i>"Reporting in the journal <a class="zem_slink" href="http://pubs.acs.org/journal/ancac3" rel="homepage" title="ACS Nano">ACS Nano</a>, researchers led by Dr. Xinyan Tracy Cui at the <a class="zem_slink" href="http://colleges.findthebest.com/l/3768/University-of-Pittsburgh-Pittsburgh-Campus" rel="fdbcolleges" title="University of Pittsburgh Pittsburgh Campus">University of Pittsburgh</a> say their new approach allows them to electronically control the release of very specific amounts of drugs to certain parts of the body. To do this, they incorporated extremely thin nanosheets of <a class="zem_slink" href="http://en.wikipedia.org/wiki/Graphite_oxide" rel="wikipedia" title="Graphite oxide">graphene oxide</a> that were loaded with the <a class="zem_slink" href="http://en.wikipedia.org/wiki/Non-steroidal_anti-inflammatory_drug" rel="wikipedia" title="Non-steroidal anti-inflammatory drug">anti-inflammatory drug</a> dexamethasone into a polymer scaffold that conducts electricity. By zapping the nanosheets with an <a class="zem_slink" href="http://en.wikipedia.org/wiki/Electric_current" rel="wikipedia" title="Electric current">electric current</a>, they were able to release the drug -- using the thickness of the sheets to control how much drug was being carried, and the number and magnitude of zaps to control how much of the drug was released."</i><br />
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<a href="https://chrome.google.com/webstore/detail/pengoopmcjnbflcjbmoeodbmoflcgjlk" style="font-size: 13px;">F</a>ull article: <a href="http://news.cnet.com/8301-11386_3-57618425-76/could-electronically-controlled-drugs-reduce-side-effects/?ttag=fbwl" target="_blank">click here</a><br />
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cralphhttp://www.blogger.com/profile/17716398305539789239noreply@blogger.com0tag:blogger.com,1999:blog-3348564512398570082.post-76219712875032225502014-01-23T12:35:00.001-07:002014-01-23T12:35:47.001-07:00Fentanyl Transdermal Patch Application Sites<div style="text-align: right;">
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<table cellpadding="0" cellspacing="0" class="tr-caption-container zemanta-img" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://commons.wikipedia.org/wiki/File:Fentanyl.svg" imageanchor="1" style="margin-bottom: 1em; margin-left: auto; margin-right: auto; text-align: clear:right;"><img alt="English: 2D structure of fentanyl" border="0" class="zemanta-img-inserted" height="169" src="http://upload.wikimedia.org/wikipedia/commons/thumb/e/e8/Fentanyl.svg/350px-Fentanyl.svg.png" style="border: none; font-size: 0.8em;" width="350" /></a></td></tr>
<tr><td class="tr-caption zemanta-img-attribution" style="text-align: center; width: 350px;">English: 2D structure of fentanyl (Photo credit: <a href="http://commons.wikipedia.org/wiki/File:Fentanyl.svg">Wikipedia</a>)</td></tr>
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We know that <a class="zem_slink" href="http://en.wikipedia.org/wiki/Fentanyl" rel="wikipedia" title="Fentanyl">fentanyl</a> <a class="zem_slink" href="http://en.wikipedia.org/wiki/Patch_%28computing%29" rel="wikipedia" title="Patch (computing)">patches</a> should be applied to dry, noninflamed, non-irradiated, hairless <a class="zem_slink" href="http://en.wikipedia.org/wiki/Skin" rel="wikipedia" title="Skin">skin</a>. Body hair may be trimmed but not shaved. Be sure to press the patch firmly in place for 60 seconds or more. If problems with adherence, use Tegaderm or Micropore.<br />
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Fact or Fiction From <a href="http://www.medscape.com/viewarticle/576398" target="_blank">Medscape</a>:<br />
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<div sizcache05723503425640559="0" sizset="335">
<b>Q: Is it true that fentanyl
patches infuse more quickly in patients with very little <a class="zem_slink" href="http://en.wikipedia.org/wiki/Subcutaneous_tissue" rel="wikipedia" title="Subcutaneous tissue">subcutaneous fat</a>?</b>
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<b>A:</b> No. The amount of fentanyl
absorbed is proportional to the surface area of the patch. The absorption rate
does not vary to any clinically significant extent between the chest, abdomen,
and thigh.<sup sizcache05723503425640559="1" sizset="0"><a href="" s_oid="functiononclick(){wmdTrack('ar-ref');}" s_oidt="2">[5]</a></sup> Fentanyl
is released from the patch into top layers of the skin (<a class="zem_slink" href="http://en.wikipedia.org/wiki/Stratum_corneum" rel="wikipedia" title="Stratum corneum">stratum corneum</a> and
epidermis), and it accumulates within these layers to form a depot. The drug is
released slowly into the systemic circulation via small <a class="zem_slink" href="http://en.wikipedia.org/wiki/Blood_vessel" rel="wikipedia" title="Blood vessel">blood vessels</a> within the
dermis. Fat tissue should not impair release, as the drug is released directly
from the skin into the <a class="zem_slink" href="http://en.wikipedia.org/wiki/Circulatory_system" rel="wikipedia" title="Circulatory system">blood supply</a>.<sup sizcache05723503425640559="0" sizset="341"><a href="">[2,5]</a></sup> </div>
<br />
<div sizcache05723503425640559="0" sizset="343">
Furthermore, fentanyl exhibits
wide tissue distribution to the lungs, kidneys, heart, spleen, brain, muscles,
and <a class="zem_slink" href="http://en.wikipedia.org/wiki/Adipose_tissue" rel="wikipedia" title="Adipose tissue">body fat</a> -- indicating a high extravascular <a class="zem_slink" href="http://en.wikipedia.org/wiki/Volume_of_distribution" rel="wikipedia" title="Volume of distribution">volume of distribution</a> (3-8
L/kg). It takes about 6 days to reach steady-state plasma concentrations after
initiating fentanyl patch therapy.<sup sizcache05723503425640559="0" sizset="344"><a href="">[5]</a></sup></div>
<div sizcache05723503425640559="0" sizset="343">
<sup sizcache05723503425640559="0" sizset="344"><a href=""><br /></a></sup></div>
<div sizcache05723503425640559="0" sizset="343">
<sup sizcache05723503425640559="0" sizset="344"><a href="">Reference 5: </a></sup></div>
<ul>
<li>Muijsers BBR, Wagstaff AJ.
Transdermal fentanyl: an updated review of its pharmacological properties and
therapeutic efficacy in chronic cancer pain control. Drugs. 2001;61:2289-2307.
<a href="http://www.medscape.com/medline/abstract/11772140">Abstract</a></li>
</ul>
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cralphhttp://www.blogger.com/profile/17716398305539789239noreply@blogger.com0tag:blogger.com,1999:blog-3348564512398570082.post-15017716986866430662014-01-23T12:04:00.000-07:002014-01-23T12:05:25.760-07:00Learn Something New qD: Methadone and Verapamil are Structurally Similar<table cellpadding="0" cellspacing="0" class="tr-caption-container zemanta-img" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
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<a href="http://commons.wikipedia.org/wiki/File:Methadone_synthesis_01.svg" imageanchor="1" style="margin-bottom: 1em; margin-left: auto; margin-right: auto; text-align: clear:right;"><img alt="English: Synthesis of methadone Deutsch: Synth..." border="0" class="zemanta-img-inserted" src="http://upload.wikimedia.org/wikipedia/commons/thumb/6/65/Methadone_synthesis_01.svg/350px-Methadone_synthesis_01.svg.png" height="73" style="border: none; font-size: 0.8em;" width="350" /></a></div>
</td></tr>
<tr><td class="tr-caption zemanta-img-attribution" style="text-align: center; width: 350px;">English: Synthesis of methadone Deutsch: Synthese von Methadon (Photo credit: <a href="http://commons.wikipedia.org/wiki/File:Methadone_synthesis_01.svg">Wikipedia</a>)</td></tr>
</tbody></table>
<div style="text-align: right;">
</div>
<div style="text-align: right;">
</div>
<div style="text-align: right;">
</div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container zemanta-img" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
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<a href="http://commons.wikipedia.org/wiki/File:Verapamil.png" imageanchor="1" style="margin-bottom: 1em; margin-left: auto; margin-right: auto; text-align: clear:right;"><img alt="structural formula of Verapamil" border="0" class="zemanta-img-inserted" src="http://upload.wikimedia.org/wikipedia/commons/thumb/f/fa/Verapamil.png/350px-Verapamil.png" height="88" style="border: none; font-size: 0.8em;" width="200" /></a></div>
</td></tr>
<tr><td class="tr-caption zemanta-img-attribution" style="text-align: center; width: 350px;">structural formula of Verapamil (Photo credit: <a href="http://commons.wikipedia.org/wiki/File:Verapamil.png">Wikipedia</a>)</td></tr>
</tbody></table>
<div style="text-align: right;">
</div>
<div style="text-align: right;">
</div>
<span style="font-family: inherit;">In a new series at OncoPRN, look for unique facts in the world of medications, oncology and <a class="zem_slink" href="http://en.wikipedia.org/wiki/Palliative_care" rel="wikipedia" title="Palliative care">palliative care</a>. </span><br />
<span style="font-family: inherit;"><br /></span>
<span style="font-family: inherit;">From<a href="http://www.medscape.com/viewarticle/441934" target="_blank"> Medscape</a>:</span><br />
<span style="font-family: inherit;"><br /></span>
<br />
<blockquote class="tr_bq">
<span style="font-family: inherit;">"<span style="background-color: white; line-height: 20.030437469482422px;"><a class="zem_slink" href="http://en.wikipedia.org/wiki/Methadone" rel="wikipedia" title="Methadone">Methadone</a> appears to have a <a class="zem_slink" href="http://en.wikipedia.org/wiki/Molecular_structure" rel="wikipedia" title="Molecular structure">molecular structure</a> similar to that of <a class="zem_slink" href="http://en.wikipedia.org/wiki/Verapamil" rel="wikipedia" title="Verapamil">verapamil</a> and may exhibit similar cardiac properties, such as <a class="zem_slink" href="http://en.wikipedia.org/wiki/Calcium_channel" rel="wikipedia" title="Calcium channel">calcium channel</a> blockade.</span><sup style="background-color: white; line-height: 0;"><a href="https://www.blogger.com/blogger.g?blogID=3348564512398570082" style="text-decoration: underline;">[10]</a></sup><span style="background-color: white; line-height: 20.030437469482422px;"> One study demonstrated that methadone, unlike morphine, significantly lowered <a class="zem_slink" href="http://en.wikipedia.org/wiki/Heart_rate" rel="wikipedia" title="Heart rate">heart rate</a> in rats (p<0 .05="" span=""><sup style="background-color: white; line-height: 0;"><a href="https://www.blogger.com/blogger.g?blogID=3348564512398570082" style="text-decoration: underline;">[10]</a></sup><!--0--></0></span></span></blockquote>
<sup style="background-color: white; color: #444444; line-height: 0;"><a href="https://www.blogger.com/blogger.g?blogID=3348564512398570082" style="color: #5757a6; text-decoration: underline;"><span style="font-family: inherit; font-size: small;"><br /></span></a></sup>
<span style="font-family: inherit;">10 Seyler DE, Borowitz JL, Maickel RP. Calcium channel blockade by certain opioids. Fundam Appl Toxicol 1983;3:536-42.</span><br />
<div>
<span style="font-family: inherit;"><br /></span></div>
<div>
<span style="background-color: white; line-height: 17.999801635742188px;"><span style="font-family: inherit;">The potential of methadone to cause adverse effects similar to verapamil must be taken under consideration clinically in any patient taking methadone or is to start methadone.</span></span></div>
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cralphhttp://www.blogger.com/profile/17716398305539789239noreply@blogger.com0tag:blogger.com,1999:blog-3348564512398570082.post-62422514040446956382014-01-16T17:07:00.001-07:002014-01-16T17:09:10.999-07:00No More Needles? 7 Ways Scientists are Attempting to Move Beyond Shots (TED Blog)<a href="http://blog.ted.com/2014/01/14/7-ways-scientists-are-attempting-to-move-beyond-needles/">No more needles? 7 ways scientists are attempting to move beyond shots | TED Blog</a>:<br />
<br />
<b>A shot through a puff of air</b><br />
<br />
"In 2012, Jack You of <a class="zem_slink" href="http://maps.google.com/maps?ll=37.46,126.95&spn=0.01,0.01&q=37.46,126.95%20(Seoul%20National%20University)&t=h" rel="geolocation" title="Seoul National University">Seoul National University</a> unveiled a device that delivers drugs through a <a class="zem_slink" href="http://en.wikipedia.org/wiki/Laser" rel="wikipedia" title="Laser">laser pulse</a>. The pulse lasts 250 millionths of a second and, through a series of reactions described on Phys.org, creates a narrow jet of medicine that is just larger than the <a class="zem_slink" href="http://en.wikipedia.org/wiki/Hair%27s_breadth" rel="wikipedia" title="Hair's breadth">width of a human hair</a>. “The impacting jet pressure is higher than the skin <a class="zem_slink" href="http://en.wikipedia.org/wiki/Ultimate_tensile_strength" rel="wikipedia" title="Ultimate tensile strength">tensile strength</a> and thus causes the jet to smoothly penetrate into the targeted depth underneath the skin,” explains Yoh. This device is intended to get medicine to the epidermal level."<br />
<br />
Full article link: <a href="http://blog.ted.com/2014/01/14/7-ways-scientists-are-attempting-to-move-beyond-needles/" target="_blank">click here</a><br />
<br />
TED - ideas worth sharing!<br />
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cralphhttp://www.blogger.com/profile/17716398305539789239noreply@blogger.com0tag:blogger.com,1999:blog-3348564512398570082.post-39959373937268625532013-12-15T11:34:00.001-07:002013-12-15T11:35:43.161-07:00Final Exit: This doctor sees death daily – but should he help suffering patients end their lives?<table cellpadding="0" cellspacing="0" class="tr-caption-container zemanta-img" style="float: right; margin-right: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="http://www.amazon.com/Final-Exit-Derek-Humphry/dp/0440504880%3FSubscriptionId%3D0G81C5DAZ03ZR9WH9X82%26tag%3Dzem-20%26linkCode%3Dxm2%26camp%3D2025%26creative%3D165953%26creativeASIN%3D0440504880" imageanchor="1" style="margin-bottom: 1em; margin-left: auto; margin-right: auto; text-align: clear:right;"><img alt="Cover of "Final Exit"" border="0" class="zemanta-img-inserted" height="300" src="http://ecx.images-amazon.com/images/I/51N9NPKHG6L._SL300_.jpg" style="border: none; font-size: 0.8em;" width="195" /></a></td></tr>
<tr><td class="tr-caption zemanta-img-attribution" style="text-align: center; width: 195px;">Cover of <a href="http://www.amazon.com/Final-Exit-Derek-Humphry/dp/0440504880%3FSubscriptionId%3D0G81C5DAZ03ZR9WH9X82%26tag%3Dzem-20%26linkCode%3Dxm2%26camp%3D2025%26creative%3D165953%26creativeASIN%3D0440504880">Final Exit</a></td></tr>
</tbody></table>
<a href="http://www.calgaryherald.com/health/Final+Exit+This+doctor+sees+death+daily+should+help+suffering/9287702/story.html">Final Exit: This doctor sees death daily – but should he help suffering patients end their lives?</a>: "Now, as his province sits poised to legalize doctor-hastened death, Borod raises a blunt question: Would euthanasia, a <a class="zem_slink" href="http://en.wikipedia.org/wiki/Lethal_injection" rel="wikipedia" title="Lethal injection">lethal injection</a> that would have abruptly stopped her breathing and her heart – a step far more aggressive than the “<a class="zem_slink" href="http://en.wikipedia.org/wiki/Palliative_sedation" rel="wikipedia" title="Palliative sedation">palliative sedation</a> therapy” he had administered – have been more humane?"<br />
<br />
<a href="https://chrome.google.com/webstore/detail/pengoopmcjnbflcjbmoeodbmoflcgjlk" style="font-size: 13px;">F</a>ull article: <a href="http://www.calgaryherald.com/health/Final+Exit+This+doctor+sees+death+daily+should+help+suffering/9287702/story.html" target="_blank">click here</a><br />
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cralphhttp://www.blogger.com/profile/17716398305539789239noreply@blogger.com0tag:blogger.com,1999:blog-3348564512398570082.post-70255475587508067292013-12-06T10:05:00.001-07:002013-12-06T10:07:52.767-07:00Are 'Super-Enhancers' The Key to Cancer Therapy?<table cellpadding="0" cellspacing="0" class="tr-caption-container zemanta-img" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
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<a href="http://www.thedoctorschannel.com/view/will-newly-discovered-super-enhancers-allow-us-to-control-genes/?utm_source=news_2013-12-03&utm_medium=email&utm_campaign=news">Will Newly Discovered 'Super-Enhancers' Allow Us to Control Genes? - The Doctor's Channel</a>:<br />
<br />
"<a class="zem_slink" href="http://www.crunchbase.com/person/nancy-simonian" rel="crunchbase" title="Nancy Simonian">Nancy Simonian</a>, MD, CEO, <a class="zem_slink" href="http://syros.com/" rel="homepage" title="Syros Pharmaceuticals">Syros Pharmaceuticals</a> elaborates on the breakthrough discovery of super-enhancers, large groups of transcriptional enhancers that drive <a class="zem_slink" href="http://en.wikipedia.org/wiki/Gene_expression" rel="wikipedia" title="Gene expression">expression of genes</a> that define cell identity. "<br />
<br />
Link to video <a href="http://www.thedoctorschannel.com/view/will-newly-discovered-super-enhancers-allow-us-to-control-genes/?utm_source=news_2013-12-03&utm_medium=email&utm_campaign=news" target="_blank">here</a>.<br />
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